Intraoperative mapping and radiofrequency ablation of the His bundle is feasible in patients with complex congenital heart disease post-Fontan operation, though the technical approach is heavily influenced by altered anatomy.
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Anatomy may dictate tailored His ablation mapping in post-Fontan patients; leaves open prospective validation of safety and reproducibility.
Intraoperative mapping and radiofrequency ablation of the His bundle (with epicardial ventricular pacing) were performed in an 18-year-old woman with complex congenital heart disease and intractable chronic atrial arrhythmias following the Fontan operation. The presence of complex intracardiac anatomy as well as the exclusion of the atrioventricular conduction tissue from the systemic venous circulation strongly influenced the technical approach.
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Urcelay et al. (1993) studied this question.
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